Health Language Blog

Revenue cycle management can leverage systems and workflows that close gaps, tie up loose ends, and ensure submission of a clean claim. Reference data—representing the coded and uncoded data used across a health system—plays an all-important role in strategies that optimize revenue cycle processes and ensure compliance with industry licensing requirements.

The introduction of industry standards such as SNOMED CT, ICD-10, LOINC, and RxNorm is an important step toward achieving the goals of interoperability and information sharing. Yet healthcare organizations still face notable challenges to laying the best frameworks for normalizing data to these standards. Since there is no one standard that addresses all healthcare information, clinical and financial data must be “cleaned” and appropriately mapped to a single source of truth to remove semantic ambiguity.

Hospitals and health systems are sitting on a wealth of patient information that has potential to transform care delivery. Yet analytics infrastructures designed to fuel performance improvement have traditionally overlooked much of that data because it resides in health IT systems as unstructured free text.

Problem lists are not new to healthcare, yet the industry has historically struggled to accurately capture this critical snapshot of patient problems and visit diagnoses. While EHRs now provide an efficient way to gather problem list data, they don’t address the underlying challenge of clean data capture due to the wide variance in terminologies used across the industry.

It’s no secret that reimbursement is increasingly complex for today’s hospitals and health systems. In truth, a fair amount of billing inaccuracies and missed charge capture has always been part of the bottom-line challenge. But today’s providers simply cannot afford to let any money slip through the cracks as they navigate new value-based care models and take on more risk.

EMR and other healthcare software applications must maintain dropdown lists of codes, which are regularly updated by the standard bodies. As a software vendor you need to ensure that you are monitoring for updates, analyzing each update to determine what actually changed, and then incorporating the updates and shipping updated code to all of your customers. In this blog, I discuss the challenge of managing codes and dropdown lists on your own, as opposed to using a terminology management solution to manage these frequent updates for you.

The Office of the National Coordinator for Health Information Technology (ONC) recently released the 2017 Interoperability Standards Advisory (ISA), an update to the 2016 version that holds great promise for advancing health information exchange. National Coordinator Vindell Washington hailed the release as “a key step toward achieving the goals” outlined in the Shared Nationwide Interoperability Roadmap and Interoperability Pledge announced earlier this year. Thus, the Interoperability theme continues as seen with the recent Cures Act and MIPS. Even HHS Secretary nominee Tom Price during his confirmation hearings stated that the federal government’s role “ought to be interoperability: to make sure the different systems can talk to each other so it inures to the benefit of the patient.”

The 21st Century Cures Act was signed into law just last month. This broad law reduces the bureaucracy for drug approval, provides billions of dollars to the NIH for research, and provides funding to state governments to deal with the opioid epidemic. But along with these touted benefits, this law includes significant impacts for healthcare IT.

National healthcare movements demand an interoperable framework for accurate data exchange across healthcare continuums. As value-based care continues to unfold, the industry at large remains focused on efforts to mature interoperability to support high-level quality initiatives aimed at improving population health and cutting costs.

For this reason, the Office of the National Coordinator (ONC) recently identified two metrics to support specific indicators of “widespread interoperability” in the industry. Developed in response to directives laid out by The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the new metrics are: